advanced to the RCA. Then exchanged again to Miraxle 6 GW which was able to cross to the proximal RCA but in false lumen causing a small vessel wall hematoma. <Antegrade> A Runthrough GW was advanced to the lesion then exchanged to Ultimate Bros 3 over a Finecross MC. A Mini Trek 2.5x20 mm balloon was inflated at conus branch for anchoring. The GW was exchanged again to Miracle 3 which was able to cross to the mid RCA. The total occlusion was crossed using conquest Pro 9 GW. Reverse CART was done using a Mini Trek 1.2x12 mm balloon at mid RCA then a Mini Trek 2.0x20mm balloon with a maximum of 16 atm. Randevuz was done in RCA GC after anchoring using a 2.5 x 20 mm balloon in the GC. The conquest pro was exchanged to Runthrough GW in the PDA branch using Mantel’s technique. A Runthrough GW loaded on Crusade MC was advanced to the PLB. The RCA was dilated with a Trek 2.5x20 mm balloon up to 20 atm and a Mini Trek 2.5x20 mm for d-PDA and PLB branches. IVUS (ilab) was done to PLB to p-RCA most of the GW was in true lumen except a small part in the mid-segment. A DES (Biomatrix 2.5x36mm) was deployed at the PLB to D-RCA with a 6 and 12 atm. A DES (Resolute 3x38mm) was deployed at the D-RCA with a 12 and 18 atm. Another DES (Resolute 3.5x38mm) was deployed at the mid-RCA with a 16 and 18 atm. Then a DES (Resolute 3.5x15mm) was deployed at the prox-RCA with a 16 and 18 atm. Postdilatation was done with a Hiryu 3x15 mm HP balloon with a maximum atm of 24 and a NC Sprinter 3.5x15 mm HP balloon with a maximum atm of 14. IVUS was repeated for RCA and showed a well opposed stents with no complications and (minimal stent area ¼ 6.95 mm2) at d-RCA. TIMI 3 flow and 2% residual stenosis (MLD/ref: 3.57/3.64mm) at p-RCA, 10% residual stenosis (MLD/ref: 3.18/3.54mm) at m-RCA, 7% residual stenosis (MLD/ref: 3.40/ 3.65mm) at d-RCA and 6% residual stenosis (MLD/ref: 3.28/3.48mm) at very distal RCA were achieved. Patient tolerated the procedure well with no immediate complication. TCTAP C-085 A Case of Two Vessel Acute Coronary Syndrome with CTO Lesion Successfully Treated with PCI Under Percutaneous Cardiopulmonary Support Maoto Habara Toyohashi Heart Center, Japan [Clinical Information] Patient initials or identifier number: S.Y. Relevant clinical history and physical exam: A 71 years old man presented to our hospital complaining of severe chest pain in the setting of inferior ST-elevation myocardial infarction (STEMI). He had no medical history except for hypertension without medication. On admission, physical exami- nation showed low blood pressure (91/57 mmHg) and sinus tachycardia (HR 113/ min). There was no pulse deficit and crackles in pulmonary auscultation. Relevant test results prior to catheterization: ECG showed sinus tachycardia, heart rate of 116/min, and ST segment elevation of 3- 5mm in inferior leads and depression of 3-6mm in antero-lateral wall leads. The echocardiography showed moderate LV dysfunction (LVEF45%). Anterior wall was moderate hypokinesis and inferior wall was akinesis. In laboratory data, cardiac enzyme was elevated ( AST 56 IU/l, CK 442 IU/l, CK-MB 33.8 IU/l, and troponin I 2.01 ). Relevant catheterization findings: Right coronary angiogram showed total occlusion with thrombus at proximal portion. Left coronary angiogram showed the sever stenosis at proximal portion and the chronic total occlusion at mid portion of LAD. In addition, there was severe stenosis at mid LCX. The distal LAD was well filled through the collateral channels from the LCX and diagonal branch. [Interventional Management] Procedural step: At first, we treated the RCA, the culprit lesion of acute myocardial infarction. Before the PCI procedure, we inserted IABP because right heart catheterization showed Forrester subset4. A 8Fr JR4.0SH guiding catheter (BritetipÒ) was engaged in the right coronary. After aspiration of thrombus, deployment of filter wire and IVUS examination, predilation with EmergeÒ 3.0-mm balloon was performed at the mid and proximal lesions of RCA. And we deployed two drug-eluting stents (Resolute-integrity 3.0*30 mm at mid RCA, Resolute-integrity 3.5*22 at proximal RCA). After treated RCA, he was treated at CCU. However, two hours after the index PCI, he complained sever chest pain again and blood pressure was also depressed (68/48 mmHg with IABP support). Therefore, coronary angiography was performed again. Right coronary angiogram showed no significant stenosis or stent thrombosis. Left coronary angiogram was not changed index CAG except high lateral branch (HLB). Although last CAG showed only mild stenosis at proximal portion of HLB, the CAG showed sever stenosis with flow delay at the portion. Therefore PCI for that lesion was performed. A 8Fr XB3.5SH guiding catheter (BritetipÒ) was engaged in the left coronary. After IVUS examination and deployment of filter wire, predilation with S120 JACC Vol 63/12/Suppl S j April 22–25, 2014 j TCTAP Abstracts/CASE/Chronic Total Occlusions CASES 19th CardioVascular Summit: TCTAP 2014